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Narcolepsy is a neurological sleep disorder classified by the brain’s inability to correctly control sleep-wake cycles. People with narcolepsy can also experience excessive sleepiness, sleep paralysis, hallucinations, and partial or total loss of muscle control triggered by strong emotions. Since the boundary between sleep and wakefulness is blurred in individuals with narcolepsy, they may involuntarily fall asleep during daily activities or experience sleeping characteristics while physically awake.  

man falling asleep at the wheel while driving

There are two types of narcolepsy: type 1 and type 2. Type 1 narcolepsy is diagnosed when an individual is found to have a decreased production of a brain hormone called hypocretin or when they report excessive tiredness coupled with cataplexy. Type 2 narcolepsy is reserved for those who exhibit excessive daytime tiredness, however do not experience cataplexy. Those with type 2 narcolepsy usually have normal levels of hypocretin and their symptoms tend to be less severe than individuals with type 1 narcolepsy.

Did You Know?

According to the National Sleep Foundation, narcolepsy is thought to affect approximately 1 in 2,000 individuals. Most men and women exhibit symptoms early on during childhood, however these symptoms often go undiagnosed until later in life.

Frequently Asked Questions:

What are the symptoms of narcolepsy?

The most commonly occurring symptoms of narcolepsy are excessive daytime sleepiness, cataplexy, sleep paralysis, and hallucinations. Everyone affected by narcolepsy experiences excessive daytime sleepiness, however only about 10-25% of individuals affected by narcolepsy experience all other symptoms.

Excessive daytime sleepiness (EDS) is classified by mental cloudiness, lack of energy, inability to concentrate, memory loss, a depressed mood, and extreme exhaustion.

Cataplexy refers to a sudden loss of muscle tone, causing extreme weakness and a loss of voluntary muscle movement. Cataplexy is usually triggered by strong emotions and exhibits itself through any

Exhausted woman sitting in front of her laptop with a cup of coffee

thing from slurred speech to total body collapse.

Hallucinations caused by narcolepsy mostly consist of vivid, frightening visual content. Although mostly visual, at times other senses may be involved. If the hallucinations occur when going to sleep, they are called hypnagogic, and if they occur when waking, then they are called hypnopompic.

Sleep paralysis is the temporary inability to move or speak and occurs when an individual is waking up or falling asleep. Sleep paralysis episodes are usually only a few seconds to a few minutes and full movement and speech is recovered when the episode ends.

Sometimes, individuals with narcolepsy can also experience episodes of insomnia or temporary sleep episodes during waking activities in which they are unaware they continue the activity unaware of the fact they were asleep.

What causes narcolepsy? 

The exact cause of narcolepsy is not currently known, however there are a few different theories. One theory posits that certain genes signal the production of sleep and awake chemicals in the brain, and that narcolepsy could be caused by a shortage of a chemical called hypocretin. This shortage may be caused by a faulty gene or by a form of autoimmune disease that attacks the part of the brain responsible for producing hypocretin.

 

How is narcolepsy diagnosed?

To diagnose narcolepsy, our sleep doctors at Overlake Internal Medicine Associates will conduct a physical exam and discuss your medical history, symptoms, and sleeping patterns. We may also have you keep a sleep diary for a week or two to get more information about your sleep patterns.

In order to rule out other neurological conditions and make an affirmative diagnosis of narcolepsy, two main tests may also be completed. The first is a sleep study that will record your brain and muscle activity, breathing, and eye movements overnight to determine when your REM cycle occurs and whether another sleep disorder is the cause of your symptoms.

Woman with eyes closed and sleep waves in the background

The next test is a multiple sleep latency test (MSLT). This test is performed during the daytime to determine how fast you can fall asleep and how quickly after falling asleep you can enter REM sleep. MSLT will have you take five short naps every two hours as the day goes on to determine your level of daytime tiredness.

A final method of diagnosing narcolepsy is to measure hypocretin levels. For this test, a sample of the fluid surrounding the brain and spinal cord is obtained through a spinal tap, and the level of hypocretin is determined to diagnose type 1 narcolepsy.

How is narcolepsy treated?

Treatment for narcolepsy is centered around the alleviation of its symptoms. Both cataplexy and excessive daytime sleepiness can be managed with medications such as Modafinil, Amphetamine-like stimulants, antidepressants, and sodium oxybate.

Certain lifestyle changes may also be beneficial to addressing symptoms. Some recommended strategies include taking short, scheduled naps to manage the daytime sleepiness, maintaining a regular sleep schedule to improve sleep, avoiding drinking caffeine or alcohol before bedtime, exercise for at least 20 minutes per day 4-5 hours before bedtime to induce sleepiness, avoid large meals or smoking before bedtime, and having a relaxing ritual before bedtime.

Can narcolepsy be cured?

Unfortunately narcolepsy cannot be completely cured. However, when treated, narcolepsy symptoms can improve. Individuals who do not receive treatment for their narcolepsy are at risk for a range of accidents where serious injury and death could occur.

Will narcolepsy get worse?

Although there is no cure for narcolepsy, the good news is that generally it will not get worse with age. As mentioned before, treatment can even help improve symptoms and make the condition more manageable.

If you are experiencing symptoms of narcolepsy, it is important to receive a diagnosis and the proper treatment as soon as possible to minimize any risks. At Overlake Internal Medicine Associates of Bellevue, our top sleep doctors can help provide you with the care you need. Schedule a consultation today!